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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440703678
Report Date: 11/05/2025
Date Signed: 11/05/2025 03:37:46 PM

Document Has Been Signed on 11/05/2025 03:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NEIGHBORHOOD CHILDCARE CENTERFACILITY NUMBER:
440703678
ADMINISTRATOR/
DIRECTOR:		HASEBE, LILYFACILITY TYPE:
850
ADDRESS:904 WESTERN DRIVETELEPHONE:
(831) 423-9073
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY: 36TOTAL ENROLLED CHILDREN: 33CENSUS: 25DATE:
11/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Lily HasebeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 11/5/2025, Licensing Program Analyst (LPA), Syeda Bahar met with Director Lily Hasebe for an unannounced case management inspection, regarding an unusual incident that was reported the San Jose Community Care Licensing on 10/23/2025. The incident involved four children, child #1 (C1), child #2 (C2), child #3 (C3), child #4 (C4), ages between 4 to 5 years old. The written report was submitted on 10/28/2025. During the visit, the LPA toured the facility and a census was taken.

On 10/22/2025, there was one staff #1 (S1), and eight children present at the time of incident. Per the incident report, one staff (S1) took the children to the playground at 4:10 PM. Four of the children stayed in the garden, and four of the children ran to play structure. Staff (S1) stated that she was at the garden with four children when the incident happened. At 4:15 PM, Staff (S1) walked to the play structure and observed a group of four children displaying behaviors that required immediate attention. Two children (C1, C2) were engaging in inappropriate behavior, while other two (C3, C4) were observing them.

During today’s inspection, LPA toured the indoor and outdoor areas of the center with the director. LPA observed the play structure is located at the backside of the playground. The back side of the play structure is not fully visible from the garden area, where staff (S1) was standing on 10/22/2025.

Based on staff interviews, staff (S1) intervened, telling the children to stop and exit the play structure. The Staff (S1) then addressed the whole group to discuss privacy and physical boundaries. The Staff (S1) also talked to the parents of the children involved in the incident. The director then contacted the licensing office and child protective services.

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NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NEIGHBORHOOD CHILDCARE CENTER
FACILITY NUMBER: 440703678
VISIT DATE: 11/05/2025
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Director stated that actions taken include parent meetings, staff training on supervision, capacity ratio and personal rights. One staff (S1) stated the center is working in developing plans and policy on supervision and attention, during the outdoor play time of the children.

Based on the interviews, it was determined that the incident occurred due to lack of supervision. Per California Code of Regulations Title 22, Chapter 1, the following deficiency is cited: (see LIC 809D).

Section Cited: CCR 101229(a)(1) - Responsibility for Providing Care and Supervision:
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement was not met as evidenced by staff interviews which indicated that, on 10/22/2025, there were lack of supervision for four children during the outdoor play time. This poses a potential health, safety, and personal rights risk to children in care.

Exit interview conducted and report was reviewed with the director, Lily Hasebe. Appeal rights were provided.

A Notice of Site Visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Susy Cervantes
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/05/2025 03:37 PM - It Cannot Be Edited


Created By: Syeda Bahar On 11/05/2025 at 02:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NEIGHBORHOOD CHILDCARE CENTER
FACILITY NUMBER: 440703678

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement is not met as evidenced by:
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By Plan of Correction (POC) due date 12/5/2025, Director will submit a written plan that details how staff will ensure all children are always visually supervised. Director will ensure that all staff receive training in the plan, and submit the agenda, attendance sheet, & training materials to the department.
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Based on staff interviews, there were lack of supervision for four children (C1, C2, C3, C4) during outdoor play time on 10/22/2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susy Cervantes
NAME OF LICENSING PROGRAM MANAGER:
Syeda Bahar
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2025


LIC809 (FAS) - (06/04)
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